2005 -- H 5590

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LC00143

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STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2005

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A N A C T

RELATING TO HEALTH -- CANCER TREATMENT FUND

     

     

     Introduced By: Representative Joanne M. Giannini

     Date Introduced: February 16, 2005

     Referred To: House Finance

It is enacted by the General Assembly as follows:

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     SECTION 1. Chapter 23-67 of the General Laws entitled "The Rhode Island Research

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and Treatment Fund for Uninsured and Underinsured Women Stricken With Cancer" is hereby

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amended by adding thereto the following section:

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     23-67-4. Payments for cancer treatment drugs. -- (a) The director shall establish and

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administer a program to pay recipients regardless of gender, for costs of drugs prescribed

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exclusively for the treatment of cancer when those costs are not otherwise reimbursed. The

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director shall establish eligibility standards and an application process by rule.

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     (b) Participation in the program shall be limited to persons whose household income is

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not greater than two hundred percent (200%) of the federal poverty level as established by the

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federal office of management and budget.

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     The program shall be available only to eligible residents who have resided in Rhode

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Island for at least twelve (12) months.

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     (c) The director shall pay a maximum amount per cancer patient based on the following:

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     (1) available moneys;

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     (2) the terms of any contract between the department of health and human services and

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the provider; and

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     (3) the reimbursement rates shall be the same as the Medicaid reimbursement rate for the

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drug, minus the copayment.

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     (d) Payment shall be made under the program to or on behalf of a program eligible

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recipient only for costs not reimbursed or eligible for reimbursement by any other third party or

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governmental entity (including, without limitation, private or group insurance, Medicaid,

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Medicare, or the veterans’ administration). The director may, however, waive this requirement in

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individually considered cases if he or she determines that its enforcement will deny services to a

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class of cancer patients because of conflicting state or federal laws or regulations. The

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department of health and human services shall make rules to ensure that all third parties and

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governmental entities (including, without limitation, private or group insurance, Medicaid,

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Medicare, or the veterans’ administration) make all required benefit payments.

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     (e) The director may restrict or categorize reimbursements to meet budgetary limitations.

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     (f) The director shall maintain a cancer drug formulary that shall include all drugs eligible

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for reimbursement by the program. The director shall establish an internal review procedure for

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updating the formulary; the procedure shall allow the addition and deletion of allowable drugs to

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the formulary. The internal review procedure shall take place at least quarterly during a fiscal

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year.

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     (g) Payments made under the program established under this section shall be made from

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the cancer treatment drug fund.

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     SECTION 2. There is hereby appropriated, out of any money in the treasury not

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otherwise appropriated, a sum sufficient to accomplish the purposes of this section. Gifts, grants,

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and donations shall also be accepted and deposited in a restricted receipt account created for that

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purpose by the treasurer. Unexpended general treasury funds shall be carried over from year to

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year.

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     SECTION 3. This act shall take effect upon passage.

     

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LC00143

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N A C T

RELATING TO HEALTH -- CANCER TREATMENT FUND

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     This act would establish a fund to assist uninsured and underinsured persons in paying for

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cancer treatment drugs.

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     This act would take effect upon passage.

     

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LC00143

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H5590